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North Carolina rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $5,011.87 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $933.25 / $2,290.87
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $1,698.24 / $2,398.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,047.13 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,047.13 / $1,949.84
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,230.27
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $954.99 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $3,890.45 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $870.96 / $1,737.80
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $5,623.41 / $45,708.82
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,760.83 / $6,760.83 / $7,943.28